Startup Health Insurer Model for Legal Insurance

I blogged recently about how research into randomized medicaid expansion might be making a case for broader use of the legal insurance concept.  How this interesting article in the Washington Post suggests how it might be done.  The article focuses on a startup that will soon be launching  new web-based health insurance provider — to be named Oscar.

As the article explains:

The idea behind Oscar is that using your insurance should be as easy and intuitive as using your Facebook account or your Tumblr page. As Nazemi puts it, “We have a responsibility to take the friction and pain of engagement out of the process.” The experience is familiar to anyone who uses today’s leading social networks (the former head of engineering at Tumblr now works for Oscar). But for anyone who has used the Web sites of Aetna or Cigna or Blue Cross Blue Shield, it’s something of a revelation.

Sign into your Oscar insurance account online, and you’ll see a few carefully chosen options on a page that’s otherwise white and clean. At the top, you can type in your symptoms and be taken immediately to a guided set of options, including a button that lets you talk to a doctor. Click it, and a doctor will call you, wherever you are, whatever time of day it is, within 20 minutes. If you need to see someone, the site will offer a list of nearby providers, tell you which ones are recommended for your condition and inform you how much each is likely to cost.

But it is not just about access, it also resonates with the data-driven triage concept we have been working on in the legal area.

Schlosser tells the story of an analysis his team ran on a database of six years’ worth of anonymous medical claims. The team looked only at episodes that began with a headache and ended on the same day they started, which means no follow-up care was needed.

“Five percent of those episodes accounted for 35 percent of the costs,” Schlosser marveled. “The people in that 5 percent all ended up at the emergency room. That was probably people who had a headache on Sunday night at 4 a.m. when the doctor wasn’t there. If you could just take that issue and move it to a different layer of care, a nurse coming to visit you or going online with a televisit, that’s win-win-win. It’s a win for the consumer. It’s a win for the providers. And it’s more cost-efficient.”

That’s the larger ambition of the founders: to change health care by building an insurance Web site that people trust to guide them through their care decisions.

So a legal version of this would be a great facilitator of early intervention, it would make it possible to use the least expensive intervention, and would ultimately reduce demand for court intervention — thus saving the state money.  Of course integrating this with non-lawyer practice would dramatically increase the options for cost savings.

I think most potential consumers of lawyer’ services are relectuant to be engage a lawyer unless that person is personally recommended by someone they trust.  A huge question in a legal insurance system would be whether people would be willing to make this jump.

Ogther huge questions are cost — and who would pay.  Most current legal insurance is part of union contacts.  Most people do not expect to need a lawyer — just like most young people do not expect to need medical care. It will be interesting to see if the educational programs associated with the Affordable Care Act figure out how to get “legally health” people to buy into the insurance concept.

The Oscar website might also teach us much about how legal portals might work.

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About richardzorza

I am deeply involved in access to justice and the patient voice movement.
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